Provider Demographics
NPI:1790463982
Name:ROSE PSYCHOTHERAPY PLLC
Entity Type:Organization
Organization Name:ROSE PSYCHOTHERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW / PRINCIPAL
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SICIGNANO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:480-321-6280
Mailing Address - Street 1:9393 E PALO BREA BND APT 2090
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-6518
Mailing Address - Country:US
Mailing Address - Phone:480-321-6280
Mailing Address - Fax:
Practice Address - Street 1:9393 E PALO BREA BND APT 2090
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-6518
Practice Address - Country:US
Practice Address - Phone:480-321-6280
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-07
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty